NAMD responds to ex parte issue

Approximately two weeks ago, CMS identified a Medicaid unwinding compliance issue with “ex parte” (automatic or passive) renewals that appears to affect many states. This issue, which has not emerged previously, revolves around whether states conduct this review at the household or individual level.  This is detailed in a letter that CMS sent to Medicaid directors today.  Specifically, CMS is invoking federal regulations and language from the Consolidated Appropriations Act of 2023 to require states to conduct ex parte renewals at the individual level.

State Medicaid programs immediately responded and are working closely with CMS to resolve specific state-by-state issues in a way that helps to keep eligible individuals – particularly children – covered, while also moving forward on Medicaid renewal obligations.  States will immediately review the guidance and do the necessary work to fulfill the requirements. While fixing this is a significant challenge given that eligibility management systems are complicated, challenging to pivot, and costly to revise, a number of states are already in compliance, and all others are actively working with their systems vendors on this.

Unfortunately, the issue of which method states are using to conduct ex parte was not raised during the initial mitigation plan stage of the unwinding process, during which CMS entered agreements with states on how they would do the work. Many states were not aware this was an issue, and some had even worked with CMS to certify their eligibility management systems without specific reference to these requirements. Further, the reason that some states have been using a household-based approach is that Medicaid member advisory boards and other sources of Medicaid member feedback recommended that states streamline the number of applications that were being sent when multiple people in the same household used the program for health insurance.

Ex parte is an important protective feature of Medicaid eligibility, and many states use it for many of the members they cover because it is helpful both to Medicaid members, in eliminating the burden of additional applications, and to Medicaid programs, in creating system efficiencies. But given the complex personal circumstances of Medicaid members, ex parte is not a magic bullet. Even while Medicaid programs have made historically unprecedented investments in outreach, engagement and systems improvement, the life challenges many Medicaid members experience on a daily basis makes participating in the system challenging.

That’s why we want to underscore that ex parte, while an important tool, isn’t and can’t be the only means of intervening for otherwise eligible folks who are not responding to renewal notices. If ex parte renewal isn’t feasible, Medicaid programs still have to provide renewals forms and pursue that process. Further, all states are also observing a reconsideration period of 90 to 120 days during which parents and children who lose Medicaid coverage can complete their renewal packet and, if found to be still eligible, have coverage reinstated. Many states have also extended reconsideration to all coverage groups.

Finally, even where all other means have been exhausted, Medicaid, unlike any other health insurance, allows eligible individuals to join at any time. No open enrollment periods. No qualifying life events. While Medicaid programs progress through the unwinding, they and countless partners are working hard to ensure that eligible Medicaid members understand all available options to support them in remaining covered.